One to one specialling and sitters in acute care hospitals: A scoping review

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Publisher: Elsevier B.V.
Document Type: Report
Length: 522 words

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To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/j.ijnurstu.2018.04.018 Byline: Victoria J. Wood [v.wood@ucl.ac.uk] (a,b,*), Cecilia Vindrola-Padros (a,b), Nick Swart (a,b), Michelle McIntosh (b), Sonya Crowe (b,c), Stephen Morris (a), Naomi J. Fulop (a) Keywords Specialling; Nurse specials; Sitters; One to one care; Scoping review Abstract Background One to one specialling is a type of care which is provided to ensure the safety of patients who may be suffering from cognitive impairment, exhibit challenging behaviour, or may be at risk of falls or of causing harm to themselves or others. Care such as this, often referred to as 'specialling' or 'sitting' is common practice in most hospitals around the world, but there is a lack of evidence regarding its cost effectiveness and the quality of care provided. Aim The aim of this scoping review was to explore the breadth and scope of literature on one to one specialling, sitters and similar types of care in acute secondary care settings, in order to identify the challenges and concerns relating to the quality of care (process and outcomes) and cost effectiveness emerging from the literature, and determine the implications of this for policy, practice and future research. Design This review was based on scoping review methodology following a five stage scoping review process. A keyword search was conducted in the following databases: MEDLINE, Scopus, CINAHL Plus, Web of Science, ProQuest Social Science, and ProQuest Nursing and Allied Health. The time limit placed on the search was January 2000 to April 2016. Inclusion and exclusion criteria were applied. The Mixed Methods Appraisal Tool was used to assess the quality of primary research articles. Findings Forty-four articles were included in the review. We found a lack of clarity in the terms used to describe one to one specialling and variability in what this type of care entails, who provides the care and the needs of patients requiring this type of care. High costs of specialling are often seen as a concern, but there was a lack of economic evaluations considering the full cost of specialling and balancing these against the benefits. Some of the articles proposed alternatives to one to one specialling or the use of sitters, but only some of these were evaluated. Conclusion There is wide variation in what specialling and one to one care entails, which can in turn lead to the provision of poor quality care. A reduction in this variation and improved quality care might be achieved through the development of guidelines, training and standardized decision-making tools. Further research on the impact of one to one specialling on patient outcomes and cost would be beneficial, as well as robust evaluations of the alternatives to specialling. Author Affiliation: (a) Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK (b) University College London Hospitals NHS Foundation Trust, London, UK (c) Clinical Operational Research Unit, University College London, London, UK * Corresponding author at: Department of Applied Health Research, 1--19 Torrington Place, London, WC1E 7HB, UK. Article History: Received 5 September 2017; Revised 26 April 2018; Accepted 27 April 2018

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Gale Document Number: GALE|A541743551